340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-1078
RRC450571-00 SHANNON MEDICAL CENTER
Print
Covered Entity Details
Entity Name
SHANNON MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC450571-00
Entity Address
120 EAST HARRIS AVENUE
SAN ANGELO, TX 76903
Medicare Provider Number
450571
Participating Start Date
1/1/2021
Last Recertification Date
Entity Termination Date
7/1/2021
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1078
Pharmacy Address
2005 HUTCHINS AVE
BALLINGER, TX 76821
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
4/27/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Joseph Wooldridge, Chief Financial Officer
(325) 657-5303
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/15/2021
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session